Comparative analysis of FoxP3(+) regulatory T cells in the target tissues and blood in chronic graft versus host disease

Activation and migration of regulatory T cells (Treg) into tissue is critical in control of inflammation, but has not been examined extensively in chronic graft versus host disease (cGVHD). In parallel studies of tissues and blood, we determined that FoxP3(+) T cells increased in proportion to T effectors (Teff) in tissue infiltrates in oral and cutaneous lichenoid cGVHD. These FoxP3(+) cells expressed distinguishing phenotypic and functional markers of Treg (CD3(+), CD4(+), CD27(+), ICOS(+) and CD39(+)), not found on FoxP3(-) Teff. Both Teff and FoxP3(+) Treg expressed T-bet and the chemokine receptor CXCR3, however, consistent with a common mechanism of chemokine-mediated migration into tissue. Furthermore, functional markers (ICOS and CD39) and chemokine receptors (CXCR3) were both present in a higher proportion of FoxP3(+) cells in tissues than in peripheral blood, consistent with recruitment and activation of Treg in cGVHD target tissues. Finally, the 'activated' CD45RA(-)FoxP3(hi) subset of Treg cells, which highly express functional markers, were found in comparable frequencies in cGVHD patients and normal controls, despite a significant deficit in naive 'resting' Treg. These findings are consistent with Treg capacity to upregulate functional markers and traffick into tissue in cGVHD.

A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities

BACKGROUND

Anger is a frequent problem for many people with intellectual disabilities, and is often expressed as verbal and/or physical aggression. Cognitive-behaviour therapy (CBT) is the treatment of choice for common mental health problems, but CBT has only recently been adapted for people with intellectual disabilities. Anger is the main psychological presentation in which controlled trials have been used to evaluate CBT interventions for people with intellectual disabilities but these do not include rigorous randomised studies.

OBJECTIVES

To evaluate (1) the impact of a staff-delivered manualised CBT anger management intervention on (a) reported anger among people with mild to moderate intellectual disabilities, and (b) anger coping skills, aggression, mental health, quality of life and costs of health and social care; (2) factors that influence outcome; and (3) the experience of service users, lay therapists and service managers.

DESIGN

A cluster randomised controlled trial based on 30 day centres (15 intervention and 15 control). Intention-to-treat comparisons of outcomes used a two-level linear regression model to allow for clustering within centres with baseline outcome levels as a covariate. Comparison of cost data used non-parametric bootstrapping. Qualitative analysis used interpretative phenomenological analysis and thematic analysis.

SETTING

Recruited day centres had four-plus service users with problem anger who were prepared to participate, two-plus staff willing to be lay therapists, a supportive manager and facilities for group work, and no current anger interventions.

PARTICIPANTS

A total of 212 service users with problem anger were recruited. Thirty-three were deemed ineligible (30 could not complete assessments and three withdrew before randomisation). Retention at follow-up was 81%, with 17 withdrawals in each arm. Two to four staff per centre were recruited as lay therapists. Eleven service users, nine lay therapists and eight managers were interviewed.

INTERVENTIONS

The manualised intervention comprised 12 weekly 2-hour group sessions supplemented by 'homework'. Lay therapists received training and ongoing supervision from a clinical psychologist. Treatment fidelity, group attendance and resources used in intervention delivery were monitored.

MAIN OUTCOME MEASURES

The primary outcome was the service user-rated Provocation Index (PI), a measure of response to hypothetical situations that may provoke anger. Secondary trial outcomes were the key worker-rated PI; the service user- and key worker-rated Profile of Anger Coping Skills (PACS); the service user-rated PACS imaginal provocation test (PACS-IPT), a measure of response to actual situations known to provoke anger; aggression; mental health; self-esteem; quality of life; and health and social care resource use. Assessments were administered before randomisation and at 16 weeks and 10 months after randomisation.

RESULTS

Fourteen treatment groups were delivered, each with 12 sessions lasting an average of 114 minutes, with a mean of 4.9 service users and 2.0 lay therapists. The mean hourly cost per service user was £ 25.26. The mean hourly excess cost over treatment as usual was £ 12.34. There was no effect of intervention on the primary outcome - self-rated PI. There was a significant impact on the following secondary outcomes at the 10-month follow-up: key worker-rated PI, self-rated PACS-IPT and self- and key worker-rated PACS. Key workers and home carers reported significantly lower aggression at 16 weeks, but not at 10 months. There was no impact on mental health, self-esteem, quality of life or total cost of health and social care. Service users, key workers and service managers were uniformly positive.

CONCLUSIONS

The intervention was effective at changing anger coping skills and staff-rated anger. Impact on self-rated anger was equivocal. With hindsight there are reasons, from an analysis of factors influencing outcomes, to think that self-rated PI was not a well-chosen primary outcome. Widespread implementation of manualised lay therapist-led but psychologist-supervised anger management CBT for people with mild to moderate intellectual disabilities is recommended.

Structural incorporation of iron into Ge–imogolite nanotubes: a promising step for innovative nanomaterials

Iron-doped aluminogermanate nanotubes were obtained using a single step, aqueous phase synthesis protocol, resulting in a novel nanomaterial.

Hepatic artery embolisation for liver metastases from neuroendocrine disease

The 2013 Alpine Liver and Pancreatic Surgery meeting was held in Madonna di Campiglio, Italy. The meeting was organised by the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland. The following abstracts were selected for presentation at the meeting.

Selective internal radiation treatment for hepatic malignancy

The 2013 Alpine Liver and Pancreatic Surgery meeting was held in Madonna di Campiglio, Italy. The meeting was organised by the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland. The following abstracts were selected for presentation at the meeting.

Sorption of arsenite, arsenate, and thioarsenates to iron oxides and iron sulfides: a kinetic and spectroscopic investigation

Sorption to iron (Fe) minerals determines the fate of the toxic metalloid arsenic (As) in many subsurface environments. Recently, thiolated As species have been shown to dominate aqueous As speciation under a range of environmentally relevant conditions, thus highlighting the need for a quantitative understanding of their sorption behavior. We conducted batch experiments to measure the time-dependent sorption of two S-substituted arsenate species, mono- and tetrathioarsenate, and compared it to the sorption of arsenite and arsenate, in suspensions containing 2-line ferrihydrite, goethite, mackinawite, or pyrite. All four As species strongly sorbed to ferrihydrite. For the other sorbents, binding of the thiolated As species was generally lower compared to arsenate and arsenite, with the exception of the near instantaneous and complete sorption of monothioarsenate to pyrite. Analysis of the X-ray absorption spectroscopy (XAS) spectra of sorbed complexes implied that monothioarsenate binds to Fe oxides as a monodentate, inner-sphere complex. In the presence of Fe sulfides, mono- and tetrathioarsenate were both unstable and partially reduced to arsenite. Adsorption of the thiolated As species to the Fe sulfide minerals also caused the substitution of surface sulfur (S) atoms by As and the formation of As-Fe bonds.

Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health

OBJECTIVES

Mainstream mental health services are providing more care for individuals with an intellectual disability (ID); this has implications for staff and service users. Attitudes of staff towards people with ID in mental health services may be negative and negative staff attitudes may have a detrimental impact on service provision.

DESIGN

A cross-sectional design was used.

METHODS

A questionnaire designed to investigate the attitudes and emotions of staff towards delivering mental health care to adults with ID was completed by 84 staff from mainstream and specialist ID services.

RESULTS

Staff in both services experienced more positive emotions when working with clients whom they are currently employed to work with. When the frequency of contact with adults with ID, the number of individuals worked with and the amount of formal ID training received were considered, there was no significant difference between the attitudes of staff in both services. Positive correlations were found between attitude scores and positive emotional experiences in both services.

CONCLUSIONS

The research suggests that numerous factors, including the role of emotional experience and a number of environmental aspects, need to be considered in the context of providing mental health services to adults with ID to ensure the highest quality. Research limitations and clinical implications of the study are also considered.

Effects of pine bark supplementation on performance, rumen fermentation, and carcass characteristics of Kiko crossbred male goats

Twenty-two Kiko crossbred male goats (Capra hircus; initial BW = 27.5 ± 1.04 kg) were used in a randomized complete block design to determine the effects of feeding pine bark (PB; Pinus taeda L.) on animal performance, rumen fermentation, blood parameters, fecal egg counts (FEC), and carcass characteristics in goats. Experimental treatments included the control diet [0% PB plus 30% wheat straw (WS)], 15% PB plus 15% WS, and 30% PB plus 0% WS (on as-fed basis), where PB replaced WS. Freshly air-dried PB and WS were finely (1.5 to 3.0 mm) ground and incorporated in the grain mixes. Experimental diets provided a total of 1.9, 16.3, and 32 g of condense tannins (CT)/kg DM in 0%, 15%, and 30% PB diets, respectively. The grain mixes were fed daily at 85% of the feed offered, with remaining 15% consisting of Bermuda grass hay (Cynodon dactylon). Animals were fed once a day at 0800 h, and feed offered and refused was monitored for an 83-d performance period. Rumen and blood samples were collected at d 0, 50, and 80 of the study. Carcass traits were assessed after slaughter at the end of performance period. There was no difference in initial BW, hay, and total NDF intake among treatments; however, final BW (P = 0.06), ADG (P < 0.01), grain mix intake (P < 0.001), total DMI (P < 0.001), and G:F (P < 0.04) increased linearly as the PB increased in the diets. Rumen ammonia N, acetate, isovalerate and acetate-to-propionate ratio were reduced linearly (P < 0.05). There was no difference in carcass traits except cold carcass weight (P = 0.06), which tended to increase linearly in goats fed 15% and 30% PB. Breast, sirloin, trim trait, liver, and hide weight increased (linear; P < 0.01) with addition of PB. Blood basophils, alanine transaminase, aspartate aminotransferase, albumin, Na, and Cl concentrations decreased (linear; P < 0.02 to 0.01) as PB supplementation increased. Supplementation of PB reduced (linear; P < 0.01) average FEC. Addition of PB in the diets improved performance, reduced FEC, and favorably modified rumen fermentation.

Appendiceal endometriosis presenting as a cecal mass

Appendiceal intussusception is described, in the surgical literature, as a rare entity with a 0.01% incidence (1). Presenting symptoms can be vague, and preoperative diagnosis is difficult. Given concerns about malignancy, complete surgical removal of the mass and histologic examination of the specimen are paramount, in order to ensure correct diagnosis and proper treatment. Herein, we describe the case of a 44-year-old woman with appendiceal endometriosis leading to intussusception.